Distortion of the terminal portion of the QRS is associated with poor collateral flow before and poor myocardial perfusion after percutaneous revascularization for myocardial infarction.
OBJECTIVE
The distortion of the terminal portion of the QRS has been related to adverse outcome in patients with ST-segment elevation myocardial infarction.


METHODS
We studied the relationship of this electrocardiographic pattern with the angiographic findings in patients treated with percutaneous revascularization for ST-segment elevation myocardial infarction. We included 349 patients, 318 treated with primary angioplasty and 31 with rescue angioplasty after failed thrombolysis.


RESULTS
Eighty-five patients were found with distortion of the terminal portion of the QRS complex (group 1) and 264 without it (group 2). Collateral flow was absent in 30 patients (35%) from group 1, versus 52 patients (20%) from group 2 [odds ratio (OR) 1.806, 1.097-2.974, P 0.019]. No-reflow occurred in 12 (14%) patients in group 1 versus 17 (6.4%) in group 2 (OR 2.388, 1.091-5.230, P 0.016). Myocardial perfusion was graded 2-3 in 28 patients (58%) of group 1 versus 98 (76%) in group 2 (OR 0.443, 0.220-0.893, P 0.021).


CONCLUSIONS
Patients with ST-segment elevation myocardial infraction showing distortion of the terminal portion of the QRS have worse collateral flow, and present more often no-reflow or poor myocardial perfusion after percutaneous revascularization. These data contribute to explain the worse clinical outcome of these patients.
Garcia-Rubira
Juan C
JC
Cardiovascular Institute, San Carlos University Hospital, Marid, Spain. drchjcgr@arrakis.es
Nuñez-Gil
Ivan
I
Garcia-Borbolla
Rafael
R
Manzano
Maria C
MC
Fernandez-Ortiz
Antonio
A
Cobos
Migel A
MA
de Isla
Leopoldo Pérez
LP
Hernández
Rosana
R
Macaya
Carlos
C
D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003097:Collateral Circulation / Q000502:physiology*; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome